Stop killing our newborns
Medical disasters claim several lives daily. A mass sterilisation camp in Chhattisgarh that killed a horde of women was followed by a cataract camp in Punjab that blinded 18 people, so by the time a report appeared on the death of five babies in a span of just 12 hours at a Tamil Nadu hospital, barely anyone noticed. Authorities at the Dharmapuri Medical College Hospital in TN say that these three to five day old infants died due to "neo-natal complications including respiratory problems”.
Some had low birth weight and others had respiratory distress syndrome when they were admitted to the neo-natal intensive care unit (NICU) of the hospital.
The fact that these newborns didn’t survive is shocking, since this particular hospital has an outstanding reputation for providing emergency medical services to pregnant women and infants in the district. A decade ago, I visited the Dharmapuri Medical College Hospital on behalf of UNICEF, to document the effectiveness of a short course provided by MOHFW to impart lifesaving skills to doctors (LSAS). At that time, the hospital was hailed for its Comprehensive Emergency Obstetric and Newborn Care Centre (CEmONC), which provided around the clock emergency obstetric and newborn care. Today, this very hospital is in the news for infant deaths. According to reports, the NICU unit intended to provide care for 30 babies a day serves nearly double that number. Lack of infrastructure, medical supplies and healthcare personnel have clearly compromised the quality of care. Every year, India loses 800,000 babies in the first 28 days of their lives, accounting for nearly one third of newborn deaths in the world. Most of these deaths are caused by premature birth, complications during birth, and infections. Mothers don’t practice exclusive breastfeeding, and facilities to detect and treat newborn complications are limited in most healthcare settings, increasing deaths from diseases like pneumonia.
The Infant Mortality Rate (IMR) is a count of the number of deaths among infants under a year old per 1,000 live births in one year, and serves as a barometer of social and economic progress. Bringing this down is one of the Millennium Development Goals (MDGs) set by the UN, with a deadline of 2015. India’s target was to bring IMR down to 28 per 1,000 births by 2015, but newborn mortality rate still averages 30 per 1000 births: The rate of progress made by the states in tackling this challenge varies.
Tamil Nadu is an exception, with a comparatively functional health system. It made news in 2010 for having crossed the millennium development target five years in advance, with an IMR of 24 per 1,000 live births. So the deaths of the five babies in quick succession is indeed a setback, and reflects a lack of planning and preparedness. Maintaining newborn health is a daunting task in most settings in India, and unless health systems gear up for the challenge, such setbacks will become the norm.
Another problem that public health experts predict will escalate and add to the burden of newborn survival is that of drug resistant infections. A Lancet report about the superbug menace in India says 58,000 infants in the country died of antibiotic resistant infections last year. Indian pediatricians say this problem is bound to escalate -- progress made in stopping babies from acquiring other diseases "could slow, stop or even reverse itself," Dr. Vinod Paul, chief of pediatrics at the All India Institute of Medical Sciences and the leader of the study, reportedly said.
Health systems will have to get ready to treat an increasing number of babies with sepsis, pneumonia, as well as drug-resistant infections. “There is no doubt that our hospitals and especially our intensive care units are breeding grounds for multi drug resistant bacteria,” says Dr Arvind Taneja, Chief Advisor, Pediatrics, Max Healthcare. “The principles of rational antibiotic use have to be constantly reinforced amongst doctors to stem this rot.”